No description available.

The current study consisted of two experiments to examine the impact of home-based therapy on mental illness in multiproblem families. Review of the literature focused on the interplay between poverty and mental illness in defining multiproblem families and the utilization of home-based therapy with this population and others. Experiment 1 focused on delineating the type and severity of psychological distress in families characterized as multiproblem. Subjects were 58 participants in the Community-Family Partnership, a Comprehensive Child Development Program located at Utah State University in Logan, Utah. In this sample, serious psychological distress was evident with depression in both women and men as a primary symptom. Female participants in Experiment 1 showed psychological distress across more subscales and higher standardized mean difference effect sizes on the global subscales of the Symptom Checklist-90-Revised than male participants. Significant distress was also evident on the Somatization and Obsessive-Compulsive subscales for female participants and on the Hostility subscale for male participants. In a corollary to Experiment 1, participants in this study also fit the description of multiproblem based on their demographic characteristics. Experiment 2 implemented a home-based therapy program based on Sherman's Action Counseling model and evaluated its effectiveness in terms of reduction of psychological distress. Six individuals drawn from the Experiment 1 sample participated in Experiment 2. At pretest, they were not demographically different from the Experiment 1 sample, and they exhibited severe psychological symptoms such that their score profiles on the Symptom Checklist 90-Revised met both definitions of caseness for that instrument. These subjects participated in nine weekly sessions of home-based therapy based on the Action Counseling model. Therapy was very successful for one subject, moderately successful for four subjects, and not successful for one subject using reduction of psychological distress as the measure of effectiveness. Additionally, Experiment 2 examined elements of the therapy that contributed to effectiveness. Mastery of and implementation of the 10 Action Counseling steps appeared to contribute to therapy success. Limitations were discussed with respect to internal and external validity in the current study. Recommendations for future work were provided.

Master of Public Health - MPH / BACKGROUND: The Zambian anti-retroviral therapy (ART) program has successfully enrolled over 770, 000 people living with HIV (PLWH), out of a population of 1.2 million PLWH. This tremendous success has overburdened the clinic system resulting in many challenges for both patients and healthcare staff. To promote ART initiation, adherence, and retention and at the same time relieve pressure on the health system, a home-based ART delivery model (HBM) was piloted in two urban communities of Lusaka. This study explored levels of acceptability of the model and factors influencing this among PLWH living in the two communities. Acceptability was defined as degree of fit between the patient’s expectations and circumstances and the home-based delivery model of ART, taking into consideration all the contextual elements surrounding the patient. METHODOLOGY: A qualitative study of HBM acceptability was nested within a clusterrandomized trial comparing outcomes in patients receiving HBM intervention compared to the standard of care in two communities in Lusaka, Zambia. Using an exploratory qualitative study design and a purposive sampling technique, qualitative data were collected using observations of HBM delivery (n=12), in-depth interviews with PLWH (n=15) and Focus Group Discussions with a cadre of community health workers called community HIV care providers (CHiPs) administering the HBM (n=2). Data were managed and coded using Atlas.ti 7 and analysed thematically. RESULTS: Overall, the HBM was found to be a good fit with the lives and expectations of PLWH and therefore highly acceptable to them. This acceptability was influenced by a combination of cross cutting clinic based, program design and socio-economic factors that have been categorized into push and pull factors. Push factors were those related to the challenges that PLWH faced when accessing ART from the clinic and included congestion, long waiting times, confidentiality breaches and stigma arising from attending a dedicated clinic. These factors resulted in considerable direct and indirect livelihood opportunity costs. The HBM as an alternative had a number of ‘pull factors’. PLHW described services offered through the model as convenient, confidential, trusted, personalized, less stigmatizing, comprehensive, client centred, responsive, and respectful. Disclosure of client’s HIV status to people they lived with was found to be critical for the acceptability of the model. CONCLUSIONS AND RECOMMENDATIONS: The HBM is highly acceptable and this acceptability is influenced by a combination of crosscutting push and pull factors. Key to the HBM’s acceptability was its delivery design that was responsive to individual patient needs and the steps CHiPs took to minimize the ever-present threat of disclosure and stigma. Future adoption and scaling up of HBM should recognize the importance of these design features.

CD4+CD25+Foxp3+ T regulatory (Treg) cells are critical in maintaining self tolerance and promoting the acceptance of allogeneic tissue/organ grafts. To be widely applied in clinical settings, there needs to be a readily available source of Treg cells, a requirement that is better met if non-histocompatible donor cells could be utilized in adoptive therapy. Therefore, to investigate the therapeutic potential of fully allogeneic Treg cells to control autoimmune disease or allograft rejection, we utilized IL-2R beta-deficient mice that exhibit rapid lethal autoimmunity due to low production of an ineffective population of Treg cells. We show that adoptive transfer of MHC-mismatched Treg cells into IL-2R beta-/- mice resulted in life-long engraftment of the donor cells, which exhibited skewed reactivity toward host alloantigens, and prevented autoimmunity. When such animals received skin grafts, they exhibited tolerance to those grafts that expressed MHC molecules from which the donor Treg cells were derived. Collectively, these data provide proof-of-principle that effective engraftment by allogeneic Treg cells controls autoimmunity and leads to favorable conditions for long-term acceptance of allografts. Current data indicates that CD4+CD25+Foxp3+ Treg cells exhibit a broad TCR repertoire. However, the relationship between this diversity and capacity to control a similarly diverse population of potentially autoreactive T cells remains to be defined. To investigate this issue, we assessed the TCR repertoire of chimeric donor Treg cells in IL-2R beta-/- mice that were adoptively treated with a diverse polyclonal Treg inoculums. We demonstrate that autoimmune disease was fully prevented by engrafted donor Treg cells in spite of a TCR repertoire that is less diverse than the input cells. However, in settings where the input TCR repertoire is limited by utilizing donor Treg cells that express a single TCR beta chain, control of disease was hampered, correlating with a limited TCR alpha repertoire within the engrafting donor Treg cells. Collectively, these findings suggest that for adoptive therapy, a diverse TCR repertoire of input Treg cell inoculums is an essential requirement for effective control of polyclonal autoreactive T cells but perturbations in the repertoire that results in significant limitation to this diversity may compromise Treg cell efficacy at fully keeping autoaggressive cells in check.

付記する学位プログラム名: 充実した健康長寿社会を築く総合医療開発リーダー育成プログラム / 京都大学 / 新制・課程博士 / 博士(医科学) / 甲第23116号 / 医科博第127号 / 新制||医科||8(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 藤田 恭之, 教授 渡邊 直樹, 教授 岩田 想 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Occupational therapy has been recognized as an essential profession in the area of low vision (American Academy of Ophthalmology, 2017). With the increasing number of older individuals developing visual impairments, focus has been placed on educating occupational therapy practitioners (OTPs) about adult and geriatric clients. However, the same emphasis has not been placed on best practices for pediatric clients with low vision. Wittich, et al. (2016) reports that entry-level occupational therapy programs do not consistently provide adequate instruction to create competence treating a sensory loss such as vision or hearing. Additionally, over 90% of school-based OTPs report having students with low vision, but only half of those therapists report having sufficient confidence to complete assessments (Workman, et al., 2016). Therefore, pediatric specific continuing education is needed for school-based OTPs to improve confidence and competence in low vision. To address this need, Expanding Horizons in Pediatric Low Vision Education (Expanding Horizons) will be created to address the educational needs of school-based OTPs. Expanding Horizons is a professional education and networking program. It will provide information and collaboration opportunities regarding the expanded core curriculum (ECC), which is required for students with visual impairment and should be vii provided simultaneously to their academic instruction (Chase, 2022; Sapp & Hatlen 2010). As part of Expanding Horizons, OTPs will have access to continuing education in each area of the ECC, a resource library, practice chats, and one on one consultation with a pediatric low vision expert. This program will allow OTPs to develop a framework for assessment strategies and opportunities for collaboration and consultation with a focus on school-based occupational therapy provision.

No description available.

Yes / Changes in world-wide population trends have provided new demands for new technologies in areas such as care and rehabilitation. Recent developments in the the field of robotics for neurorehabilitation have shown a range of evidence regarding usefulness of these technologies as a tool to augment traditional physiotherapy. Part of the appeal for these technologies is the possibility to place a rehabilitative tool in one’s home, providing a chance for more frequent and accessible technologies for empowering individuals to be in charge of their therapy. this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for home-based rehabilitation after stroke. Methods: the project uses a user-centred design methodology to develop a hand/wrist rehabilitation device for home-based therapy after stroke. The patient benefits from a dedicated user interface that allows them to receive feedback on exercise as well as communicating with the health-care professional. The health-care professional is able to use a dedicated interface to send/receive communications and remote-manage patient’s exercise routine using provided performance benchmarks. Patients were involved in a feasibility study (n=23) and were instructed to use the device and its interactive games for 180 min per week, around 30 min per day, for a period of 6 weeks, with a 2-months follow up. At the time of this study, only 12 of these patients have finished their 6 weeks trial plus 2 months follow up evaluation. Results: with the “use feasibility” as objective, our results indicate 2 patients dropping out due to technical difficulty or lack of personal interests to continue. Our frequency of use results indicate that on average, patients used the SCRIPT1 device around 14 min of self-administered therapy a day. The group average for the system usability scale was around 69% supporting system usability. Conclusions: based on the preliminary results, it is evident that stroke patients were able to use the system in their homes. An average of 14 min a day engagement mediated via three interactive games is promising, given the chronic stage of stroke. During the 2nd year of the project, 6 additional games with more functional relevance in their interaction have been designed to allow for a more variant context for interaction with the system, thus hoping to positively influence the exercise duration. The system usability was tested and provided supporting evidence for this parameter. Additional improvements to the system are planned based on formative feedback throughout the project and during the evaluations. These include a new orthosis that allows a more active control of the amount of assistance and resistance provided, thus aiming to provide a more challenging interaction. / This work has been partially funded under Grant FP7-ICT-288698(SCRIPT) of the European Community Seventh Framework Programme.

Bakgrund: Naturens positiva inverkan på hälsa har belysts sedan antiken. Forskning kring naturbaserad terapi har ökat de senaste decennierna och terapiformen har gett positiva effekter för flertalet patientgrupper. Mer än en tredjedel av EU:s befolkning lider av någon form av psykisk ohälsa och många går utan adekvat behandling. Omvårdnad vid psykisk ohälsa ska enligt riktlinjer innefatta ett personcentrerat förhållningssätt och utformas utifrån kunskap om vårdmiljöns betydelse. Syfte: Att beskriva betydelsen av naturbaserad terapi för personer med psykisk ohälsa. Metod: En allmän litteraturstudie med systematisk ansats genomfördes. Artikelsökning gjordes i PubMed, Cinahl, AMED, PsykInfo och Scopus. Valda artiklar kvalitetsgranskades och analyserades utifrån kvalitativ innehållsanalys. Resultat: Den naturbaserade terapin hade en positiv inverkan på hälsa för personer med psykisk ohälsa. Resultatet baserades på 17 artiklar och speglades i fyra kategorier: naturen som tillflyktsort, betydelsen av social kontext, förändrad syn på livssituation samt symtomförbättring och dess konsekvenser. Konklusion: I studien framkom att naturbaserad terapi kan ha stor betydelse för tillfrisknande och daglig funktion för personer med psykisk ohälsa. Studien visar även att omvårdnad som utgår ifrån ett salutogent perspektiv i en terapeutisk naturmiljö bidrar till en förbättrad psykisk hälsa. / Background: The positive impact of nature on health has been highlighted since ancient times. The scientific research about nature-based therapy has increased during the last decades and has presented positive effects for patients with different diagnoses. More than one third of the European Union population suffers from some kind of mental illness and many lack adequate treatment. Nursing care of mental illness should according to guidelines include a person-centered approach and knowledge about the significance of the care environment. Aim: To describe the impact of nature-based therapy for people with mental illness. Method: A general literature study with a systematic approach was conducted. The search for articles was made in PubMed, Cinahl, AMED, PsykInfo and Scopus. The quality of the selected articles were examined and analyed using qualitative content analysis. Results: Nature-based therapy had a positive impact on health for people with mental illness. The result was based on 17 articles and four categories were identified: nature as a refuge, the importance of social context, altered view of life situation and improvement of symptoms and its consequences. Conclusion: The findings conclude that nature-based therapy can have an impact on recovery and daily function for persons with mental illness. The study also revealed that nursing care with a salutogenic approach in a therapeutic nature environment leads to an increased mental health.

Depression är en global sjukdom och miljoner människor i världen är drabbade. Socialstyrelsen rekommenderar bland annat kognitiv beteende terapi (KBT) vid depressionsbehandling, och internetbaserad KBT (iKBT) blir allt mer vanligt. Fysisk aktivitet anges som möjlighet vid depressionsbehandling och forskning visar att fysisk aktivitet verkar både symtomreducerande och förebyggande mot depression. Målet med uppsatsen var att utforska upplevelsen av fysisk aktivitet som komplement i psykologisk behandling vid depression, motiverande respektive hindrande faktorer för ökning av fysisk aktivitet vid depression samt utveckla en modul i ett internetbehandlingsprogram och undersöka upplevelsen av denna. Tio semistrukturerade intervjuer genomfördes med nio psykologer och en individ som genomgått depressionsbehandling via internet. Erfarenheten av depressionbehandling, fysisk aktivitet och internetbaserad behandling varierade inom gruppen. Genom en induktiv och deduktiv tematisk analys fastställdes fem huvudteman: Tilltro till fysisk aktivitet som komplement i behandling, Hinder för utförandet av fysisk aktivitet i allmänhet och vid depression, Faktorer för att öka sannolikheten till fysisk aktivitet vid depression, Modulens sätt att förmedla information och Modulens viktigaste faktorer. I studien framkom att fysisk aktivitet ses som ett viktigt komplement i behandling av depression, men att hinder kan begränsa utförandet av den. Det framkom även att motiverande faktorer är viktiga inslag i behandlingen för att öka aktiviteten och nå varaktig beteendeförändring. Modulen upplevdes som ett viktigt tillägg till Depressionshjälpen men bör revideras utifrån vissa faktorer. / Depression is a global illness and millions of people over the world are affected. Socialstyrelsen recommends Cognitive Behavioral Therapy (CBT) for depression treatment, and computer based CBT (iCBT) is becoming more common. Physical activity is listed as one possibility for treatment of depression and research shows that it reduces symptoms as well as prevents depression. The aim of this study was to investigate the experience of physical activity as a complement to psychological treatment of depression, motivational and preventive factors for increase of physical activity for people with depression, and develop a module in a computer based treatment program and explore the experience of it. Ten semi-structured interviews were conducted with nine psychologists and one person who had undergone computer based depression treatment. The experience of depression treatment, physical activity and internet based treatment varied within the group. From both inductive and deductive thematic analyses five main themes were established: Confidence in physical activity as a complement in treatment, Obstacles for the execution of physical activity in general and during depression, Factors that could increase the likelihood of physical activity during depression, The module’s way to convey information and The module’s most important factors. The main results of the study showed that physical activity is an important complement in treatment for depression, but obstacles could reduce its execution. Motivational factors are important for increasing and maintaining physical activity. The module was experienced as an important addition to Depressionshjälpen but should be revised based on certain factors.